CHECK OFF LIST FOR CODE BOARD OF APPEALS
The items listed below are requirements of the application process for the Code Board of Appeals.
Check off the items that accompany this appeal. If item is deemed not applicable put N/A in place of a check
mark. If any box is not marked with either a check mark or N/A, the application will be considered incomplete
and will not be accepted.
5 copies of Appeal (pages 3 thru 5)
5 copies of Tax Map
5 copies of Deed
5 copies of Agreement of Sale or Lease Agreement
5 copies of Detailed Plan of Proposed Structure
5 copies of deed searches if your application is for certification of non-conforming use
5 copies of exhibits which would include but are not limited to pictures, diagrams, and changes.
Application must be notarized. Original must be submitted.
Applications and all required material as described must be placed in packet form as follows:
Appeal
Plot plan
Tax map
Deed
Agreement of sale or lease agreement if applicable
Detailed plan of proposed structure
Deed searches, if applicable
Exhibits and specific code references
Notify all adjoining owners by certified mail. Township will provide a list of adjoining properties to be notified.
The Building & Planning staff members are not authorized to fill out your board application, correlate the above
items or answer technical questions. If you are not sure how to go about appealing to the Building Code Board
of Appeals, it is advised that you obtain an attorney to help you.
Attached to this checklist is the appeal and instructions on how to fill out the appeal form.
Plot plans may be hand drawn as long as all information is accurate. It must contain all pertinent information.
A detailed plan means a plan that shows what you are building.
Tax maps may be obtained either in Doylestown at the courthouse or in the township building. In order for us to
provide you with a copy your tax map, you will need your tax parcel number from your tax bills. The courthouse
telephone number is 215-355-7497. Ask for tax mapping.
You can obtain a copy of your deed from the Recorder of Deeds office in Doylestown.
Notarization. Have the first copy notarized. When you make copies the notarization will show up on all the
copies. Submit all copies plus the original.
Important: the Zoning Hearing Board requires submission of proof of notification, of adjoining
property owners before your appeal can be heard.
1
BENSALEM TOWNSHIP
Building and Planning Department
2400 Byberry Road Bensalem PA 19020
215-633-3644 FAX 215-633-3653
BENSALEM TOWNSHIP
Building and Planning Department
2400 Byberry Road Bensalem PA 19020
215-633-3644 FAX 215-633-3653
Township of Bensalem, Bucks County, Pennsylvania
Notice of Appeal
Appeal is hereby made by the undersigned from the action of the Code Official.
Check applicable item(s):
Application for Validity Challenge
Code Official in refusing my application for a building permit dated:
Special Exception
Appellant Name:
Address:
Phone No.
Owner’s Name:
Address:
Phone No.
Attorney Name:
Address:
Phone No.
Interest of appellant, if not owners (agent, lessee, etc.):
2
Appeal Number:
Code Board of Appeals
Exhibit C-4
1. Application relates to the following:
2. Brief description of Real Estate affected:
Tax Parcel Number:
Location:
Lot Size:
Present Use:
Proposed Use:
Present Zoning Classification:
Present Improvement upon Land:
Deed recorded at Doylestown in Deed Book: Page
Building Code Type of Const. Classification:
Building Code Building Use Classification:
3. If this is an appeal to challenge, provide a statement and/or basis for challenge to the validity of the
zoning ordinance.
4. If this is an Appeal from action of the Administrative Officer, then complete the following:
Date Determination was made:
Your statement of alleged error of Zoning Administrative Office:
3
Check items if applicable:
Use Lot Area
Height Yards
Existing Building Proposed Building
Occupancy
Other: (describe)
5. Specific reference to section of the applicable code upon which application for special relief (if special
or variance is desired). Provide a copy of the specific code reference that is being appealed in each
packet.
6. Action desired by appellant or applicant (statement of relief sought or special exception desired):
7. Reasons appellant believes board should approve desired action (refer to section or sections of
ordinance under which it is felt that desired action may be allowed.
8. Has previous appeal or application for special exception or variance been filed in connection with
these premises?
Specifications of errors must state separately the appellant's objections to the action of the zoning
administrative office with respect to each question of law and fact which is sought to be reviewed.
I, hereby depose and say that all of the above statements and the statements contained in any papers
or plans submitted herewith, are true to the best of my knowledge and belief.
Appellant's or Owner's Signature Date
Sworn to and subscribed before me this
day of 200
Notary Public
4
YES NO
My commission expires:
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signature
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